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Objective@#To explore the association of 21 gene recurrence score(RS)according to TAILORx standard and prognosis of hormone receptor(HR) positive, axillary lymph node negative breast cancer.@*Methods@#The clinicopathologic data of 558 early breast cancer patients who underwent 21 gene RS testing from May 2012 to Jan 2017 were retrospectively analyzed. RS was subgrouped according to TAILORx standard.Estimates of relapse free survival(RFS) were made from the Kaplan-Meier curves.@*Results@#In 558 patients, RS≤10, RS 11-25 and RS≥26 groups accounted for 23.1%, 63.6% and 13.3%.After a median follow-up of 38 months, the recurrence ratesin RS≤10, RS 11-25 and RS≥26 groups were 3.3%, 4.5% and 5.4%, respectively. Kaplan-Meier RFS curve showed no significant difference between the 3 groups(P=0.788). The recurrence ratesin RS≤15 group(3.0%) was significantly lower than that in RS≥16 group(5.9%)(P=0.041).@*Conclusions@#A significant association exists between RS and breast cancer prognosis.It is rational not to give chemotherapy to RS<18 low risk patients according to classical standard.
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Objective To explore the association of 21 gene recurrence score (RS)according to TAILORx standard and prognosis of hormone receptor (HR) positive,axillary lymph node negative breast cancer.Methods The clinicopathologic data of 558 early breast cancer patients who underwent 21 gene RS testing from May 2012 to Jan 2017 were retrospectively analyzed.RS was subgrouped according to TAILORx standard.Estimates of relapse free survival(RFS) were made from the Kaplan-Meier curves.Results In 558 patients,RS≤10,RS 11-25 and RS≥26 groups accounted for 23.1％,63.6％ and 13.3％.After a median follow-up of 38 months,the recurrence ratesin RS ≤ 10,RS 11-25 and RS ≥ 26 groups were 3.3 ％,4.5％ and 5.4％,respectively.Kaplan-Meier RFS curve showed no significant difference between the 3 groups(P =0.788).The recurrence ratesin RS ≤ 15 group(3.0％) was significantly lower than that in RS≥ 16 group(5.9％)(P =0.041).Conclusions A significant association exists between RS and breast cancer prognosis.It is rational not to give chemotherapy to RS ＜ 18 low risk patients according to classical standard.
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Objective@#To explore the association between the 21-gene recurrence score (RS) and clinicopathologic characteristics as well as prognosis in patients with axillary lymph node negative, hormone receptor (HR) positive breast cancer.@*Methods@#The clinicopathologic data of 439 early breast cancer patients who underwent 21 gene RS testing was retrospectively analyzed. According to the 21 gene RS, the patients were divided into low risk (295 cases), intermediate risk (111 cases) and high-risk (33 cases) group. The relationship between the 21 gene RS and clinicopathological characteristics, treatment, recurrence and metastasis was analyzed. Univariate and multivariate statistical analyses were used to analyze the risk factors for relapse free survival (RFS).@*Results@#Tumor grade, estrogen receptor (ER), progesterone receptor (PR) and Ki-67 index were significantly different among the 3 risk cohorts (P<0.001 for all). After a median follow-up of 32 months, the recurrence rate in low risk group (3.7%) was significantly lower than that in the intermediate-high risk group (9.0%), the locoregional recurrence (LRR) rate of low, intermediate and high risk group was 2.4%, 6.3% and 9.1%; and the distant metastasis (DM) rate in low risk group was 1.4% and 2.1% in the intermediate-high risk group. Univariate analysis showed RS, ER status and endocrine therapy were prognostic factors for RFS (P<0.05 for all). Multivariate analysis showed that RS was an independent significant predictor for RFS (P=0.04).@*Conclusions@#The 21-gene RS is related to tumor grade, ER, PR and Ki-67 index. RS is an independent risk factor for RFS in patients with hormone receptor positive early-stage breast cancer.
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Objective To explore the safety and cosmetic effect of nipple-sparing modified radical mas tectomy and immediate tissue expander implantation with single circumaereolar incision.Methods 30 patients were enrolled in Peking Union Medical College Hospital between Jan.2014 and Dec.2015.All the patients were categorized according to surgical incision (single circumaereolar incision group vs double incisions group).Data on clinicopathological parameters,average hospital stay,complications and overall cosmetic effect were retrospectively collected.Data was performed with Chi-square test,Fisher exact test and t-test.Statistical significance was defined as P＜0.05.Results 19 patients were enrolled in single circumaereolar incision group,and 11 patients in double incisions group.There was no significant difference for operation duration (P=0.093) and average hospital stay (P=0.339).After follow-up for 19.1 months,ranging from 8 to 31 months,no patients developed seroma or arm lymphedema.There was no statistical significance between the two groups in terms of sensation in nippleaereolar area (P=0.973),bilateral symmetry (P=0.650) and overall cosmesis (P=0.483).Conclusion single circumaereolar incision nipple-sparing modified radical mastectomy and immediate tissue expander implantation can be one of the preferable surgical procedures with benefits of minimal invasiveness,reliable oncological safety and decent cosmetic effect.
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Objective To explore the association of estrogen receptor β expression with different stages and molecular subtypes of invasive breast cancer.Methods The clinicopathologic data of 446 invasive breast cancer cases was retrospectively analyzed.ERβ expression was evaluated by types and stages.Results Of all 446 invasive breast cancer cases,328 (73.5％) were ERβ positive.The ERβ positive rate was 77.9％ (240/308) and 63.8％ (88/138) in ERα + group and ERα-group,respectively.The ERβ expression in breast cancer was positively correlated with ERα (P ＜ 0.01) while it had no correlation with PR,histological grade,HER-2 and Ki-67 (P ＞ 0.05).ERβ expression was not significantly different among different age,tumor size and axillary lymph node groups(all P ＞ 0.05).A total of 418 invasive breast cancer cases were recruited for pathologic stage and NPI analysis,including 168 cases at stage Ⅰ,152 cases at stage Ⅱ and 98 cases at stage Ⅲ.ERβ expression was not significantly different among different stages of breast cancer(P =0.743).Analyzed in these 418 cases,NPI was ＜ 3.4 in 126 cases,3.4-5.4 in 207 cases and ＞ 5.4 in 85 cases.ERβ expression was not significantly different among different NPI group (P =0.644).The ERβ positive rate in Luminal A subtype,Luminal B1 subtype,Luminal B2 subtype,HER-2 subtype and TN subtype was 75.6％ (88/118),75.9％ (110/145),85.2％ (46/54),68.4％ (39/57) and 62.5％ (45/72) respectively.ERβ expression was significantly different between Luminal subtype and non-Luminal subtype (P =0.007).Conclusions ERβ was not differentially expressed among different breast cancer stages and NPI groups.ERβ was differentially expressed in different breast cancer molecular subtypes.
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Objective:To analyze the distribution, clinico-pathologic features, and survival status of different subtypes in axillary lymph node-negative invasive breast cancer patients. Methods:In this study, data of 183 patients were included and retrospectively ana-lyzed in terms of age distribution, clinico-pathologic features, disease-free survival (DFS), and overall survival based on different sub-types (luminal, basal-like, and HER-2 over-expression). Results:No significant differences in age, tumor size, and TNM stage was ob-served among different subtypes. The relapse rates of luminal, basal-like, and HER-2 over-expression subtypes were 3.9% (4/102), 20.4% (10/49), and 6.3% (2/32), respectively (P=0.002). The death rates of luminal, basal-like, and HER-2 over-expression subtypes were 2.0%(2/102), 6.1%(3/49), and 3.1%(1/32), respectively (P>0.05). Kaplan-Meier analysis showed that the DFS of basal-like sub-type was much lower compared with that of the luminal and HER-2 over-expression subtypes (P=0.002). Cox analysis showed that the subtype was an independent prognostic indicator (P=0.001). Conclusion:In node-negative invasive breast cancer, no significant differ-ences in age distribution, tumor size, and TNM stage was observed among different subtypes. The basal-like subtype has the worst prog-nosis. Therefore, subtype is an important independent prognostic indicator.
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<p><b>OBJECTIVE</b>To investigate the safety and efficacy of trastuzumab administered concurrently with anthracycline-containing adjuvant regimen for breast cancer.</p><p><b>METHODS</b>It is a prospective, randomized and controlled trial. Participants were randomized to receive trastuzumab administered concurrently or sequentially with anthracycline-containing adjuvant regimen. The primary endpoint was cardiac safety. The second endpoints were disease-free survival (DFS) and overall survival (OS).</p><p><b>RESULTS</b>One hundred and nine breast cancer patients were enrolled and randomized in this trial. Fifty-five participants received trastuzumab administered concurrently with anthracycline-containing adjuvant regimen and 54 patients received trastuzumab administered sequentially with anthracycline. The primary cardiac event was asymptomatic decrease in the left ventricular ejection fraction (LVEF). There was no significant difference between concurrent and sequential groups in cardiac event rates (9.1% vs13.0%, P = 0.556), neither of LVEF values at basline or at 3, 6, 9 and 12 months during trastuzumab treatment (P > 0.05). Four patients (7.3%) in the concurrent group suffered local recurrences or distant metastases, and 6 participants (11.1%) in the sequential group had distant metastases. There was no significant difference between the two groups in DFS (P = 0.724). There was no death in both groups.</p><p><b>CONCLUSIONS</b>Trastuzumab administered concurrently with anthracycline is a safe adjuvant regimen for breast cancer and does not increase cardiac events. Further research is needed to determine the efficacy of this treatment regimen.</p>
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Adult , Female , Humans , Middle Aged , Anthracyclines , Antibodies, Monoclonal, Humanized , Antineoplastic Combined Chemotherapy Protocols , Therapeutic Uses , Breast Neoplasms , Drug Therapy , Pathology , General Surgery , Carcinoma, Ductal, Breast , Drug Therapy , Pathology , General Surgery , Chemotherapy, Adjuvant , Disease-Free Survival , Follow-Up Studies , Liver Neoplasms , Lymphatic Metastasis , Neoplasm Recurrence, Local , Prospective Studies , Stroke Volume , TrastuzumabABSTRACT
Breast cancer is the leading cause of malignancy-related mortality in women worldwide. The more accurate prediction of lymph node metastasis and evaluation of personalized prognosis of breast cancer patients could provide evidence and reference for individualized comprehensive treatment and clinical decision-making. Nomogram is statistical calculation model developed to generate individualized prediction of a certain clinical event through the factors associated with it. Currently breast cancer related nomogram models is most commonly used in the prediction of non-sentinel lymph node status in patients with sentinel lymph node-positive breast cancer, sentinel lymph node metastasis in clinical node-negative breast cancer and prognosis evaluation of breast cancer. This article reviewed the recent advances in breast cancer related nomograms according to the above mentioned three aspects, and evaluated respectively the predictive factors, accuracy, characteristics and clinical application potential.
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Background and purpose: With the development of the means of preoperative diagnosis and treatment of breast cancer, ifne needle puncture no longer seems to be popular with the clinical use. The safety and effectiveness of fine needle aspiration as preoperative diagnosis of breast cancer are controversial. This study was aimed to investigate the application of fine needle aspiration (FNA) of breast cancer and association between FNA and recurrence and metastasis for 30 years in our hospital. Methods:A total number of 1 260 patients with breast cancer treated in Peking Union Medical College Hospital from 1975 to 2006 were reviewed in two groups for clinical characters, recurrence, and survival rate. The two groups were FNA and non-FNA. Results:The positive rate of FNA was 61.4%and the highest rate was inⅣstage (100%). StageⅡandⅢwere the major ones in FNA group (45.2%). The local recurrence (7.0%vs 6.4%), recurrence and metastasis (13.2%vs 14.0%), 5-year (82.0%vs 81.0%) and 10-year disease free survival rates (51.0%vs 64.0%) have no signiifcant difference between FNA and non-FNA groups. Conclusion:FNA is still one of the most important methods for preoperative investigation of breast cancer. Background and purpose: With the development of the means of preoperative diagnosis and treatment of breast cancer, ifne needle puncture no longer seems to be popular with the clinical use. The safety and effectiveness of fine needle aspiration as preoperative diagnosis of breast cancer are controversial. This study was aimed to investigate the application of fine needle aspiration (FNA) of breast cancer and association between FNA and recurrence and metastasis for 30 years in our hospital. Methods:A total number of 1 260 patients with breast cancer treated in Peking Union Medical College Hospital from 1975 to 2006 were reviewed in two groups for clinical characters, recurrence, and survival rate. The two groups were FNA and non-FNA. Results:The positive rate of FNA was 61.4%and the highest rate was inⅣstage (100%). StageⅡandⅢwere the major ones in FNA group (45.2%). The local recurrence (7.0%vs 6.4%), recurrence and metastasis (13.2%vs 14.0%), 5-year (82.0%vs 81.0%) and 10-year disease free survival rates (51.0%vs 64.0%) have no signiifcant difference between FNA and non-FNA groups. Conclusion:FNA is still one of the most important methods for preoperative investigation of breast cancer.
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Objective To explore the clinical characteristics,pathology,prognosis and proper treatment of tubular carcinoma of the breast. Methods The clinical data of 11 patients with tubular carcinoma of the breast treated in Peking Union Medical College Hospital were retrospectively analyzed.Results The incidence of tubular carcinoma of the breast account for 0.4% of the total breast cancer cases.Eight out of 11 cases had palpable painless lumps in the breast.Six cases received modified radical mastectomy,among which one patient received modified radical mastectomy of both sides.Four patients underwent breast conservation therapy.Sentinel lymph nodes biopsy was conducted in 2 patients.By immunohistochemistry ER was positive in 6 cases,PR was positive in 7 cases,2 cases were axiilary lymph node positive.Three patients received chemotherapy.Two patients received endocrine therapy(tamoxifen or aromatase inhibitor).Other patients received combined therapy including radiation,endocrine therapy and chemotherapy.All the patients have been followed up from 1 month to 7 years and within the period there is no recurrence,metastasis and death. Conclusion Tubulax carcinoma of the breast is a kind of low malignant tumor.Proper surgery and adjuvant therapy is important to improve survival and the quality of life.
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<p><b>OBJECTIVE</b>To study the clinical manifestations, diagnostic methods, surgical management and prognosis of patients with neurogenic tumors of the mediastinum.</p><p><b>METHOD</b>One hundred and ten patients with neurogenic tumors of the mediastinum were analyzed retrospectively.</p><p><b>RESULTS</b>After operation, 2 patients died in hospitalization and 8 experienced such complications as Horner's syndrome or laryngeal recurrent nerve paralysis. In 102 patients with benign tumors, 2 patients had recurrence, and 4 patients with neurofibrosarcoma or malignant neurilemmoma died within 3 years postoperatively.</p><p><b>CONCLUSIONS</b>Most neurogenic tumors of the mediastinum are benign and could be diagnosed by chest X-ray or CT. The clinical manifestations, diagnosis methods, surgical management of the dumbbell tumors differ from others. Minimal invasive surgery and video assist thoracoscopy surgery are of special value in treatment of the selected neurogenic tumors of the mediastinum. Benign neurogenic tumors rarely recur after complete resection, and malignant neurogenic tumors have poor prognosis.</p>
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Adolescent , Adult , Aged , Child , Female , Humans , Male , Middle Aged , Mediastinal Neoplasms , Diagnosis , Mortality , General Surgery , Neurilemmoma , Diagnosis , Mortality , General Surgery , Neurofibroma , Diagnosis , Mortality , General Surgery , Prognosis , Retrospective StudiesABSTRACT
Objective To investigate the pathogenesis of diagnosis and treatment for delayed gastric emptying(DGE) after pancreaticoduodenectomy(PD).Methods The clinical data of 226 patients admitted between 1983 and 2001 undergoing PD were retrospectively analysed.Results In 226 PD cases DGE was observed in 62 patients(27.4%). Patients with DGE had longer duration of nasogastric tube drainage(21 days vs. 5.6 days).All patients were treated by non-operative methods. The average recovery time was 21 days.Conclusions It is emphasized that DGE has been associated with several factors, including preoperative status of diabetes, bowel obstruction, and jaundice,and postoperative pancreatic fistula, intra-abdominal abscess. Octreotide administration had no relation with the occurrence of DGE.
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ObjectiveTo evaluate the potential prognostic factors, and to better define appropriate treatment strategies for patients with phyllodes tumor of the breast. MethodsFourteen patients treated primarily for phyllodes tumor of the breast were reviewed retrospectively.Results The median age was 35 years. According to the histologic criteria of WHO, there were 5 benign cases(36%), 5 borderline cases(36%), and 4 malignant cases(29%). Seven patients underwent local excision, 4 cases did simple mastectomy, and 3 cases did modified radical mastectomy. Follow-up was obtained for 11 cases, with an average of 19 months. One patient died from metastasis 2 years after a modified radical mastectomy. Three patients treated by local excision presented local recurrence.Conclusion The outcome of phyllodes tumor appears to be determined by the biology of the tumor rather than by treatment modality. A wide local excision, with an adequate margin of normal breast tissue is the preferred initial therapy for phyllodes tumor of the breast.